Obstetric physical examination

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Obstetric physical examination

• In the initial presentation, full physical
  examination should be done.
• Abdominal pelvic examination remains important
  exam for pregnant women because it is the easiest
  method of fetal monitoring.

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Essential definitions that you should know to
understand the physical examination findings

• The presentation is the part of the fetus in the
  lower pole of the uterus overlying the pelvic
  brim (cephalic, breech)

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• The lie of the fetus is the relation of the long
  axis of the fetus to the uterus (could be
  longitudinal, oblique or transverse. only
  longitudinal lie is normal)

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• The attitude is the posture of the fetus
  (flexion, deflexion, extension)

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• The position of the baby in relation to the
  presenting part of the mothers pelvis. It is
  expressed according to the denominator which is
• occiput in vertex presentation
• sacrum in breech presentation
• mentum in face presentation

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• Station engagement
• Station is the relation of the presenting part
  to the ischial spine. If the presenting part is
  at the level of ischial spine, station 0
• Engagement the descent of the biparietal
  diameter through pelvic brim. If the head is at
  the level of ischial spine the head must be
  engaged.

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Method of abdominal exam

• Inspection
• Size of the uterus assess
• If the length breadth are both increased ?
  multiple pregnancies, polyhydramnios
• If the length is increased only ? large baby
• Shape of the uterus length should be larger than
  broad this indicates longitudinal lie. But if the
  uterus is low and broad indicates transverse
  fetus lie.
• Fetal movement
• Contour of the abdomen full bladder may be
  visible in late pregnancy. Umbilicus may become
  everted
• Skin changes look for stretch marks, linea
  nigra, scars that indicates previous surgeries

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Method of abdominal exam

• Palpation by Leopold maneuver-4 maneuvers
• Palpate the fundus (to determine if it contains
  breech, head)
• By gentle pressure
• if soft consistency/ indefinite outline ? breech
• If hard, smooth, well defined ? head
• Move your fingertips over the fetal mass to
  determine mobility and sixe
• If cant move independent from the body ? breech
• If moves freely between fingertips ? head

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Method of abdominal exam

• Lateral palpation (determine the position of the
  fetal back and small parts)
• Hands are placed on each side of the umbilicus.
  The fetal spine will palpate as firm, flat and
  linear. The fetal extremities are palpable by
  their varying contour and movements. The purpose
  of this maneuver is to determine whether the
  fetal back is left or right.

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Method of abdominal exam

• Pelvic palpation 2 maneuvers
• Grasp the lower poles of the uterus between
  fingers and thumbs and comment of the size,
  flexion and mobility of the head.
• To determine the position of the vertex
  presentation try to palpate the prominences
  (occiput _at_ the same side of the back sincipital
  _at_ the opposite side of the back)
• If the sinciput is higher the occiput ? well
  flexed
• If both prominances are at the same level ?
  deflexed
• If cant palpate the prominances, and the bulk of
  the head is felt at the same side of the back ?
  extended

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occiput
siniciput)
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Method of abdominal exam

• Auscultation help assess fetal well being
• Auscult the whole abdomen trying to locate the
  point of maximum intensity
• Dont forget to perform a pelvic exam (details of
  pelvic exam will be discussed in gynecological
  exam) but important landmarks to notice during
  pelvic exam are
• Pubis symphasis
• Ischial spine

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After you examine a pregnant women you should
answer the following questions

• 1. What is the fundal height?
• It is estimated by centimeters from upper border
  of the fundus to the pubis symphasis by taping
  measure. The height of the fundus correlates well
  with the gestational age especially during the
  weeks of pregnancy.

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After you examine a pregnant women you should
answer the following questions

• 2. lie of the fetus only longitudinal lie is
  normal
• 3. Attitude normally it is full flexion and
  every fetal joint is flexed.
• 4. presentation normally cephalic
• 5. position according to the dominator
• 6. Is the vertex engaged?

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Examination during labor

• Palpate uterine contractions
• Assessment of the cervix dilatation
• 1 finger ? 1-2 cm dilated
• 2 fingers ? 3-4 cms dilated
• 3 fingers ? 5-6 cms dilated
• 4 fingers ? 7-10 cms dilates

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• 3. Effacement of the cervix thinning of the
  cervix () or length (cm). The cervix is normally
  3-5 cms. If cervix is about 2 cm from external to
  internal os ? 50 effaced

50 effaced
100 effaced
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• 4. Consistency of the cervix soft vs. hard.
  During labor the cervix becomes soft.
• 5. Position of the cervix posterior vs.
  anterior. During labor the cervix changes from
  posterior to anterior.
• 6. Membrane is intact or ruptured assessed by
  fluid collection in the vagina